silenced by it

silenced by it.

i was very conscious about my decision to not do pediatrics.  sick children break me.  but at Reach Out clinic, we see kids sometimes.  today i saw a boy who is 12 with AIDS and TB, coming for fever, cough, diarrhea, and vomiting.  he was diagnosed last year with HIV, his cd4 count was 11.  he's now on ARV (anti-retroviral meds), he's on TB treatment, but he has difficulty with adherence.  he is neglected at home.  his mother is also sick, and they are poor.  he walked 3km to clinic alone. sick and alone. 

as i talked with him i kept my hand on his back- his thin and wraspy back that rattled when he breathed or spoke.  i lifted his shirt to listen to his chest.  he was covered in the same rash that covered his face.  he also had shingles lesions crusted over all along the lower right side of his back, his body was old- old and sick. i moved the stethascope around to all the regions of his lungs, and his heart, my hair was loose and hung long over my face- thankfully- because i cried.  i stayed there hidden in my hair listening to his distended abdomen, holding his clubbed fingers.  somehow he symbolized everything that is wrong with the world- everything broken- a sick child born sick.  a sick child with a sick mother, a father who'd abandoned them, two dead grandmothers, two dead uncles and no one to just pick him up and hold him.

i so wanted to.  i wanted to take him on my lap and tell him he is loved.  that he is valuable.  i wanted to feed him a big meal and put his many pills in a neat pill box and make sure he took them.  i wanted to give him hot chocolate and tuck him in a bed at night under a mosquito net and help him to feel safe- to have hope- to see a future other than what he lives.


was that all i cried about under that shield of my hair? or was it for the woman who lives at someones house and does work for them so they will pay her sons school fee's- who has no income for herself- except the beans she is fed twice a day.  she hates beans- but is thankful that her son is learning- thankful that she is still here and able to work after 8 years on ARVs- after coming back from nearly dead.


or was it the woman with high-grade cervical dysplasia who didn't have enough money to get to the hospital for further evaluation and treatment.  i explained the importance, the necessity of going and she understood- but it would cost about a day's wage and she doesn't work.  i have a car, i drive by her neighborhood three times a week going into town- she has a need- she needs a ride.  we tried to figure out a time, a place, a way for me to pick her up and take her- but her english wasn't good and my luganda even worse.  she had a need, she didn't ask, but i could give her bus money, which i did- the price of a latte.
'thank you', she kept saying, 'thank you for helping me to live.'


or was it the skin and bones baby who tried to smile in the arms of his weeping mother.   the 4 months old boy- who is starving before her eyes- who eats and eats but is unable to gain weight.  this child who has been to two 'health centers' and turned away with out a diagnosis or treatment.  this broken child brought in by his broken mother- begging for an HIV test- because why else would her baby be dying?


i didn't mean to cry.  i didn't want to, i really didn't want anyone to know that under my curtain of hair- i broke.  but i did. 


i'm the only muzungu at Reach Out- well except for a kid from germany who volunteers in the lab. no one understands what i'm doing here.  they keep asking why we left the USA- why we moved to uganda.  they ask with concern about our children- are they in a good school?
i explain yes- they are. i explain that we came because we feel we are supposed to be here- because there is a need and we happen to have a desire and the ability to help meet the need- like a puzzle piece.  it's not a huge sacrifice because we fit- because this is where we want to be.  our great gladness, the worlds great need- they meet- for us, they meet here.


it's not that i think i can fix any of it really.  and it's not so much that i will run away.  but the need can scream so loud sometimes that it hurts.  the disparity, the discrepancy, the random injustice of who is born where.  someone born with a silver spoon, someone born with a sexually transmitted disease. someone working all day for food and her sons school fees, someone else able to send her kids to private international school and never have to eat beans because she doesn't like them either.  someone with an infant unable to thrive and no good access to care, someone else able to fly back to the US if we were sick in an instant.  someone unable to pay the bus fare to get treated for her possible cancer, someone else with 4 wheel drive complaining about an outdated tape deck.   i see my excess everywhere.  but i will try, and i will give, and i will remember, and i will impress upon my children as best i can- how fortunate we are- and to whom much is given, much is required. 

i drove quietly to the boys school biting my lip- so i wouldn't cry again.  it was pretty and each parent around me inquired genuinely about their little persons day.  such focus on each detail of the story, a kiss for each little bump, an ooh and ahhh over each letter formed or picture drawn.  i didn't just hug the boys when i got them- i clung to them. 



and i was silenced by it.